Introduction
Spiritual care is a core part of palliative care, but its delivery remains inconsistent, and its intervention evidence base is still only moderate to low. Foundational reviews and policy-oriented syntheses agree that spirituality has been embedded in palliative care since its origins and is recognized in major definitions of palliative care, yet it remains one of the least developed dimensions in routine practice (Gijsberts Reference Gijsberts2022; Best et al. Reference Best, Vivat and Gijsberts2023; Ursoleo et al. Reference Ursoleo, Calì and Losiggio2024). Across patient-, caregiver-, and clinician-focused studies, spiritual concerns commonly include meaning, hope, peace, relationships, forgiveness, guilt, fear of dying, and connection to something beyond the self, with religion relevant for some but not all patients (Gijsberts Reference Gijsberts2022; Corpuz Reference Corpuz2023; Coelho et al. Reference Coelho, Querido and Costeira2025).
The strongest broad conclusion is that attention to spiritual needs is associated with better spiritual well-being, quality of life, coping, and decision support, while neglect of those needs is linked to distress and poorer care experiences. Large reviews and multinational qualitative work not only report positive effects of spiritual care on comfort and quality of life but also emphasize weak standardization, limited trials, and inadequate outcome measurement (Selman et al. Reference Selman, Brighton and Sinclair2017; Chen et al. Reference Chen, Lin and Yan2018; Austin et al. Reference Austin, Lee and Keall2024). The field also shows a persistent implementation gap: staff often value spiritual care but report limited training, unclear role boundaries, lack of time, and cultural uncertainty (Batstone et al. Reference Batstone, Bailey and Hallett2020; Laranjeira et al. Reference Laranjeira, Dixe and Querido2023; Costeira et al. Reference Costeira, Querido and Ventura2024).
For Hindus, spirituality is closely intertwined with daily life, religious beliefs, and cultural practices (John and Taylor Reference John and Taylor2022; Kumar et al. Reference Kumar, Nitu and Kumari2024). Hindu philosophy views illness not only as a physical condition but also as part of life’s spiritual journey, where suffering may be understood through concepts such as karma, dharma, and acceptance (Puchalski Reference Puchalski2006). Spiritual practices including prayer, chanting sacred mantras, meditation, temple worship, and family rituals provide comfort, strengthen faith, and promote emotional resilience during serious illness (Munshi and Bhagwan Reference Munshi and Bhagwan2025). These practices are particularly important in palliative care, where patients often seek peace, dignity, and meaning as they approach the end of life.
Within Hindu families, spiritual care is largely provided by family caregivers rather than healthcare professionals alone. Family members actively facilitate religious rituals, encourage spiritual practices, provide emotional reassurance, and maintain social and religious connections that support patients throughout the caregiving journey (Ismail et al. Reference Ismail, Sazali and Shahadan2025). Their involvement reflects the family-centered nature of palliative care, where spiritual well-being extends beyond the patient to include caregivers themselves. However, caregivers frequently experience considerable emotional, physical, and practical challenges while balancing caregiving responsibilities with their own spiritual and psychosocial needs.
Although spiritual care has received growing attention in palliative care research, existing studies have predominantly focused on patients’ spiritual needs or healthcare professionals’ perspectives. Comparatively little is known about how Hindu family caregivers understand spiritual care, the roles they assume in providing it, and the challenges they encounter, particularly within the multicultural healthcare context (Uzun et al. Reference Uzun, Başar and Sarıtaş2024) like Malaysia. This knowledge gap limits the development of culturally sensitive nursing interventions that effectively support both patients and family caregivers.
Understanding the experiences of Hindu family caregivers is particularly relevant for nursing practice in multicultural societies, where nurses routinely care for patients from diverse religious and cultural backgrounds (Cáceres-Titos et al. Reference Cáceres-Titos, Porras-Santana and Cabillas-Romero2025). Greater insight into Hindu spiritual caregiving can strengthen culturally competent nursing practice, facilitate respectful communication, and improve holistic palliative care that is responsive to patients’ beliefs and values.
Therefore, this study aimed to explore the perspectives of Hindu family caregivers regarding spiritual care in palliative settings, specifically to (1) understand their perceptions of spiritual care, (2) identify their roles in providing spiritual support to family members receiving palliative care, and (3) explore the challenges they encounter while delivering such care.
Methods
Study design
This study employed a descriptive qualitative design to explore the perspectives of Hindu family caregivers regarding spiritual care in palliative settings. A descriptive qualitative approach was chosen because it enables researchers to obtain rich descriptions of participants’ experiences and perceptions in their natural context without imposing a predetermined theoretical framework (Sandelowski Reference Sandelowski2000). Data were collected through semi-structured, one-to-one interviews, allowing participants to openly share their experiences while enabling the interviewer to probe emerging issues for greater depth and clarification. This study aimed to explore Hindu family caregivers’ perspectives on spiritual care in palliative care, identify their roles in providing spiritual support, and explore the challenges they encounter.
Study setting and sample
The study was conducted in Kuantan, Pahang, Malaysia. Participants were recruited from Sultan Ahmad Shah Medical Centre (SASMEC) and the surrounding community using purposive sampling, followed by snowball sampling to identify additional eligible participants. Eligible participants were Hindu family caregivers aged 18 years or older who had experience caring for a family member receiving palliative care and were able to communicate in Malay or English. Caregivers with cognitive impairment or those unable to participate in verbal interviews were excluded.
Recruitment continued until data saturation was achieved, defined as the point at which no new themes or meaningful insights emerged from successive interviews. Preliminary analysis indicated that saturation was reached after the 10th interview, and 2 additional interviews were conducted to confirm the completeness of the findings. The final sample comprised 12 Hindu family caregivers with diverse caregiving experiences.
Data collection
Data collection for this study was conducted between April and July 2024 through semi-structured interviews held at the SASMEC and with participants from the public. Each interview session lasted 40–45 minutes to accommodate participants’ schedules while ensuring enough time to gather meaningful insights.
Prior to the interviews, participants were provided with information sheets and consent forms explaining the study’s purpose, procedures, and the voluntary nature of their involvement. Participants were informed of their right to withdraw from the study or decline to answer specific questions without any consequences. Written consent was obtained from all participants, including permission to record the interviews for transcription purposes.
The semi-structured interview guide was developed based on the study objectives and relevant literature on spiritual care in palliative care. The guide consisted of broad, open-ended questions that explored caregivers’ understanding of spiritual care, their experiences in providing spiritual support, and the challenges encountered during caregiving. Examples of the interview questions included:
“What does spiritual care mean to you?”
“Can you describe how you provide spiritual care to your family members?”
“What challenges have you experienced while providing spiritual care?”
Probing questions were used when appropriate to encourage participants to elaborate on their responses.
The interviews were digitally audio-recorded and later transcribed verbatim to maintain accuracy. Once the transcription process was complete, the original recordings were securely deleted to ensure participant confidentiality and data security.
Data were analyzed using Braun and Clarke’s 6-phase thematic analysis. First, the interview recordings were transcribed verbatim and repeatedly read to achieve familiarity with the data. Second, meaningful segments of text were assigned initial codes. Third, similar codes were grouped into potential categories and themes. Fourth, the preliminary themes were reviewed and refined to ensure they accurately reflected the participants’ accounts and the entire dataset. Fifth, each theme was clearly defined and named. Finally, the themes were interpreted and supported using representative quotations from participants. Data collection and analysis were conducted concurrently, allowing emerging findings to inform subsequent interviews and facilitating the determination of data saturation.
Trustworthiness
To enhance the trustworthiness of the findings, several strategies were employed. Credibility was established through member checking, whereby selected participants reviewed the researchers’ interpretations to ensure they accurately reflected their experiences. Peer debriefing was undertaken among the research team throughout the coding and theme development process to minimize individual researcher bias. Dependability was supported by maintaining an audit trail documenting methodological decisions and analytical processes. Confirmability was enhanced through regular discussions among the researchers to achieve consensus on coding and theme interpretation, while rich descriptions and representative quotations were presented to strengthen the transferability of the findings.
Findings
The semi-structured interviews were conducted from April to July 2024, involving 12 Hindu family caregivers (3 males and 9 females) aged between 23 and 75 years (Table 1).
Sociodemographic background of the participants
Table 1 Long description
Participant characteristics are listed by pseudonym with age, participants work, gender, marital status, relationship, and diagnosis. There are 12 participants labeled P1 through P12, with ages 23, 28, 30, 33, 34, 36, 36, 39, 40, 45, 67, and 75. Gender includes 9 females and 3 males; marital status includes 9 married, 2 single, and 1 divorced. Participants work includes engineer, lecturer, teacher, student, pensioner, self-employment, nurse, and housewife, with nurses appearing 4 times and housewife appearing 4 times. Relationship entries are son for P1, P2, and P11; mother for P3 and P12; daughter for P4, P5, P6, P9, and P10; sister for P7; and niece for P8. Diagnoses listed are stroke for P3, P4, P6, and P8; mandibular cancer for P1; ovarian cancer for P2; breast cancer for P5 and P12; lung cancer for P7; kidney failure for P9; heart failure for P10; and prostate cancer for P11.
Three major themes and 9 subthemes emerged from the analysis (Table 2). The themes describe caregivers’ understanding of spiritual care, their role in providing spiritual support, and the challenges encountered while caring for family members receiving palliative care.
Themes and subthemes identified from the interviews
Table 2 Long description
Columns are Theme, Sub-theme, and Representative meaning, listing three numbered themes with three sub-themes each. Theme 1, Perceiving Spiritual Care as a Source of Meaning and Hope, includes sub-themes Spiritual care as trust in God, Spiritual care as emotional encouragement, and Spiritual care as holistic well-being, with meanings about hope and acceptance, motivation and resilience, and needs beyond physical care. Theme 2, Integrating Spiritual Practices into Family Caregiving, includes Facilitating religious practices with examples prayer, temple visits, Sanskrit chanting, Vibuthi, and reading holy books; Providing emotional and family support with encouragement, companionship, spending time together, and maintaining family relationships; and Integrating spiritual care into daily caregiving by combining physical care with emotional and spiritual support. Theme 3, Navigating Emotional and Practical Challenges in Spiritual Caregiving, includes Emotional burden of caregiving with stress, sadness, patience, and caregiver fatigue; Patients emotional responses with denial, sadness, withdrawal, and difficulty accepting illness; and Limited access to spiritual resources with lack of information, financial constraints, limited hospice support, and visiting restrictions.
Perceiving Spiritual Care as a Source of Meaning and Hope
The participants viewed spiritual care as more than just a coping mechanism. It fosters emotional resilience and promotes holistic healing by addressing both spiritual and psychosocial needs, reinforcing the bond between caregivers, patients, and their faith communities.
Spiritual care, for me, sometimes it will give calmness. It’s like a belief, right? When you’re sick, you have your family, you have your loved ones. But who are you going to believe in to help you? It must be somebody higher than you. That’s what spiritual care is about trust, you give your entire thing that, okay, I cannot handle this. I mean, I’ve tried my best. So, God help me. That’s what I understand about spiritual care. (P2)
For me, it’s like giving my father encouragement. Encouraging him to be okay again. After that, we took them to temple to pray for them. We encouraged him to read the holy book when he had free time. (P6)
In this context, spiritual care was described as a holistic approach – it goes beyond the physical aspects of health, touching on the mental and emotional well-being of both patients and caregivers. Participants underscored that this sense of inner strength and peace plays a critical role in improving quality of life, allowing patients to maintain hope and optimism
“Spiritual is some kind of motivation. When you pray you will feel calmer.” … “But there are parts that you will feel that there’s something above that you can get help, like, when you are hopeless, you are out of any options. Doctors’ medicine helps, but you want some kind of power. So, there is the God that gives help. It all depends on God, who gives us peace.” (P2)
Integrating Spiritual Practices into Family Caregiving
Caregivers also found that participating in these spiritual activities alongside the patients strengthened their emotional bond and provided mutual support. The shared experience of spiritual care fosters connection not only between the patient and caregiver but also with their faith community, promoting holistic well-being and a sense of purpose throughout the caregiving journey. This approach highlights the integrative role of spirituality in maintaining emotional stability and reinforcing resilience in both caregivers and patients.
For Hindus, we do have these kind of mantras and stuff that we recite whenever we feel down or we feel lost and we are in the seek of spiritual guidance, we do recite all these kinds of mantras. So, it is one of the ways that I myself provide to someone who needs spiritual care. (P7)
The way we provide spiritual care is we have Sanskrit chant. We play Sanskrit chant and read Sanskrit. So that he can hear. Every time he hears it, his mind becomes calm. That’s our belief. The chant has power and Sanskrit’s power will give him strength. We also have sacred ash which is Vibuthi and place it under the pillow. This is to protect him so that no evil spirits come near him. (P8)
Family caregivers who consistently fulfill these obligations suggest that they enhance the patients’ overall quality of life. Their ability to seamlessly blend spiritual, emotional, and practical support creates a well-rounded caregiving experience, addressing not only the patients’ physical health but also their mental and spiritual well-being. This comprehensive approach promotes resilience, comfort, and hope, ensuring that patients feel valued, supported, and empowered throughout their palliative care journey.
Friends and relatives do visit my father during visiting hour. This make my father become happy cause there is someone that he can talk with. (P1)
“For someone who’s down, if we encourage them, they’ll be okay again. This can be done to improve their spirit. Like, my dad’s sick, we encourage him, even though he can’t, he tries.” … “I’d spend the whole day with him.” … “We’ll just spend time with him. We’d have a conversation and take care of him. My siblings and I wash his diapers together, give him food, give him medicine, and check dextrose together.” (P6)
Navigating Emotional and Practical Challenges in Spiritual Caregiving
Participants expressed that spiritual practices provide emotional relief and help them manage their stress. Engaging in prayer, meditation, and other spiritual activities not only supports the patient but also offers emotional solace to caregivers, enabling them to recharge and continue their caregiving journey with renewed strength and purpose. The study underscores the importance of providing caregivers with emotional support and access to spiritual resources to help them navigate these challenges effectively and sustain their well-being.
We need to be patient. We need to be more diligent. Because as you know, taking care of that sick is tiring and not easy. Sometimes, I become stressed due to there are other works that need to be focused on. (P3)
At first my sister wouldn’t be able to accept that she is sick. She became sad and locked herself in room. (P7)
Participants also face challenges in accessing spiritual resources, which affects their caregiving. Many lack knowledge about what resources are available and how to use them. This uncertainty makes it hard to meet the spiritual needs of their loved ones.
Discussion
Perceiving Spiritual Care as a Source of Meaning and Hope
Participants emphasized that spiritual care is deeply rooted in religion and belief in God, viewing God as a higher authority. This connection to faith serves as a vital coping mechanism for family members, helping them manage the emotional and practical challenges associated with caregiving in palliative care. Arrey et al. (Reference Arrey, Bilsen and Lacor2016) define religion as the beliefs, practices, and language that unite a community in search of deeper meaning, often centered around faith in a divine power. Their study found that strong faith helped HIV-infected women adhere to treatment and cope with their illness, believing that God guided their healing. Similarly, participants in this study expressed that chronic diseases could potentially be healed through faith and a deep spiritual connection to God.
Participants also highlighted that spiritual care serves as a source of motivation. Zrínyi (Reference Zrínyi2014) explains that spirituality provides motivation and a broader perspective, extending beyond material interests. It fosters an intentional relationship with spiritual realities – such as meanings, norms, and values – that shape our understanding of life, relationships, and the world. This suggests that spirituality plays an integral role in forming a comprehensive understanding of existence and helping individuals find purpose and meaning in their lives.
While participants acknowledged that spiritual care is often associated with religious practices, they emphasized that spirituality encompasses more than religion. Evangelista et al. (Reference Evangelista, Lopes and Costa2016a) describe spirituality as involving both religious and nonreligious practices that allow individuals to find meaning, purpose, and connection – to oneself, others, the world, nature, and the sacred.
The World Health Organization also recognizes the significance of spiritual care in health care, stating that it is essential for enhancing quality of life and should be integrated into patient care (Nissen et al. Reference Nissen, Viftrup and Hvidt2021). Nurses play a critical role in addressing patients’ spiritual needs, which helps them cope with the difficulties of illness. As Evangelista et al. (2016) highlight, comprehensive nursing care must include biological, psychological, social, and spiritual dimensions to meet patients’ holistic needs. Understanding spirituality is, therefore, essential for providing effective nursing care and fostering healing and well-being.
Integrating Spiritual Practices into Family Caregiving
Family plays a central role in supporting patients, especially in palliative care, where their presence is invaluable. Participants emphasized that family members are essential providers of spiritual care, engaging in caregiving, spiritual practices, meditation, and yoga. These actions not only uplift the mental well-being of patients but also enhance the overall quality of care provided.
Participants reported engaging in spiritual practices such as praying to God, taking kavadi, and listening to spiritual songs and mantras, believing these rituals foster healing and strengthen their connection to God. Srivastava et al. (Reference Srivastava, Barmola and Student2013) found a positive link between intercessory prayer (praying for others) and improved health outcomes, even for patients unaware they were being prayed for. This suggests that prayer can have a beneficial impact on health and recovery.
In addition to prayer, meditation and yoga are widely practiced by Hindu caregivers to support palliative care patients. Razzaq and Basharat (Reference Razzaq and Basharat2020) describes meditation as a vital practice for achieving spirituality, with yoga being a key form of meditation that serves both as spiritual exercise and worship. Panjwani et al. (Reference Panjwani, Dudani and Wadhwa2021) note that yoga, rooted in Indian culture, promotes mental, spiritual, and physical well-being. It enhances emotional balance and helps regulate homeostasis by influencing sleep patterns and brain functions.
Caregivers also engage in practical caregiving duties, which are essential for providing holistic spiritual care. They offer emotional support, companionship, and presence, visiting patients regularly to improve their emotional and mental well-being. Ortega-Galán et al. (Reference Ortega-Galán, Ruiz-Fernández and Carmona-Rega2019) highlight that caregiving is an inherently emotional endeavor, with the primary goal of enhancing the patient’s sense of well-being. Caregivers perform tasks such as alleviating symptoms, managing pain, communicating with healthcare professionals, and ensuring patients feel comfortable and supported (Nysaeter et al. Reference Nysaeter, Olsson and Sandsdalen2024).
Maintaining connections with family and friends is also regarded as a key aspect of caregiving. Gardner et al. (Reference Gardner, Tan and Rumbold2020) noted that caregivers believe these connections play an essential role in boosting patients’ self-esteem and promoting a positive self-perception. Participants shared that visitors, quality time with loved ones, and easy phone access foster a sense of belonging. Family caregivers found comfort in sharing meals with patients and valued the flexibility to visit whenever needed, emphasizing that these simple acts provide emotional support and contribute to a more meaningful caregiving experience.
Navigating Emotional and Practical Challenges in Spiritual Caregiving
Family caregivers providing spiritual care to palliative patients face significant emotional distress, sadness, and stress. Caring for terminally ill loved ones is mentally and physically exhausting, requiring patience, time, and resilience. Farhadi et al. (Reference Farhadi, Mohammadi-Shahboulaghi and Rassouli2022) note that the burden of caregiving often leads to physical, emotional, financial, and occupational stress. This compounded stress can result in anger, dissatisfaction, and a reduction in the quality of spiritual care provided, as caregivers struggle to balance multiple demands.
Caregivers also reported that patients’ unstable emotions complicate the provision of spiritual care. Sultana et al. (Reference Sultana, Tasnim and Sharma2021) highlight that patients in palliative care often experience poor mental health due to their illness and the psychological impact of lifestyle changes. Some patients deny their condition, which can result in aggressive behavior, isolation, and emotional withdrawal. These behaviors place additional strain on caregivers, making it difficult to offer consistent emotional and spiritual support. The participants emphasized that continuous spiritual support from both family caregivers and nurses is essential to help patients cope with these emotional challenges. However, the ongoing distress can result in psychological trauma for both patients and caregivers, highlighting the emotional complexity of caregiving.
Another significant challenge is limited access to spiritual resources, which affects caregivers’ ability to meet their patients’ spiritual needs. Traveling long distances to access spiritual care services adds to the stress of caregiving. Some participants reported living far from the city where hospice services or spiritual centers are located, requiring them to undertake demanding journeys to access these resources (Lalani et al. Reference Lalani, Duggleby and Olson2021).
In addition, financial constraints present a major challenge for caregivers. Participants shared that financial stress limits their ability to access distant spiritual resources, creating additional burdens. Gardiner et al. (Reference Gardiner, Robinson and Connolly2020) observed that financial pressures are a common concern for many caregivers, especially when balancing caregiving responsibilities with the costs associated with spiritual care. The inability to afford necessary services and the burden of travel expenses further intensify caregivers’ emotional stress.
Overall, these challenges underscore the need for health-care providers and policymakers to recognize and support family caregivers by addressing their emotional, logistical, and financial needs. Ensuring better access to spiritual resources and financial assistance can alleviate caregiver stress, allowing them to provide more effective and compassionate spiritual care.
Implications for nursing practice
The findings have several implications for nursing practice. First, nurses should routinely assess and address patients’ and family caregivers’ spiritual needs as an integral component of holistic palliative care. Second, nurses should actively collaborate with family caregivers, recognizing their central role in facilitating spiritual practices and providing emotional support throughout the caregiving journey. Third, nursing education and continuing professional development programs should strengthen competencies in spiritual care, with an emphasis on culturally and religiously sensitive approaches to caring for patients from diverse backgrounds. Finally, healthcare institutions should establish supportive policies and interdisciplinary practices that facilitate the integration of spiritual care into routine clinical care, enabling health-care providers to deliver person-centered, holistic, and culturally responsive palliative care.
Strengths and limitations
This study provides in-depth insights into the experiences of Hindu family caregivers in providing spiritual care within palliative settings, contributing to the limited evidence on spiritual caregiving among religious minority groups in Malaysia. By employing a qualitative approach, the study offers a rich understanding of caregivers’ perceptions, roles, and challenges, generating findings that may inform culturally and spiritually sensitive nursing practice.
Several limitations should be acknowledged. The study was conducted in a single geographical setting, which may limit the transferability of the findings to other healthcare contexts or cultural populations. Although participants varied in age and caregiving experiences, the sample included a higher proportion of female caregivers than male caregivers, which may have influenced the perspectives captured. This imbalance may reflect the gendered nature of family caregiving in palliative care but may underrepresent the experiences of male caregivers. Future research should include participants from diverse geographical regions, healthcare settings, and religious or cultural backgrounds to further strengthen the evidence base for culturally responsive spiritual care in palliative nursing.
Conclusion
This study explores the role of spirituality in Hindu family caregiving, focusing on caregivers’ perspectives, their specific roles in palliative care, and the challenges they encounter. The findings show that Hindu family caregivers highly value spiritual practices – such as prayer, meditation, and maintaining connections with loved ones. These practices provide emotional and spiritual support, fostering peace, resilience, and emotional well-being for both caregivers and patients, ultimately enhancing the overall caregiving experience.
Family caregivers play a pivotal role in integrating spiritual elements into regular care routines, benefiting not only the patients’ health and well-being but also their own emotional balance. However, caregivers face numerous barriers to providing effective spiritual care, including emotional distress and limited access to religious resources. These challenges highlight the complexities of caregiving, emphasizing the need for adequate support and resources to ensure caregivers can continue offering high-quality spiritual care.
The study underscores the importance of integrating spiritual care into palliative care frameworks, advocating for healthcare systems to recognize the value of spiritual care in meeting patients’ holistic needs. Addressing the barriers faced by caregivers and incorporating spiritual support into standard palliative care practices is essential for improving quality of life during the end-of-life journey.
The findings offer valuable implications for health-care providers involved in palliative care. Understanding the spiritual beliefs, practices, and caregiving experiences of Hindu families can help healthcare professionals deliver culturally and spiritually sensitive care that respects patients’ values and preferences. Integrating spiritual care into routine nursing practice through effective communication, family engagement, and recognition of diverse religious traditions may enhance holistic care, strengthen therapeutic relationships, and improve the quality of life of patients and their families. Furthermore, these findings support the development of culturally competent health-care services and educational programs that prepare health-care providers to meet the spiritual needs of patients from diverse cultural and religious backgrounds.
In conclusion, this study calls for a more inclusive approach to palliative care, ensuring that the emotional, spiritual, and physical needs of both patients and caregivers are met. This comprehensive understanding can guide future efforts to improve the delivery of spiritual care and provide tailored support for families and health-care providers navigating the challenges of caregiving.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Acknowledgments
The involvement and contributions of participants in the completion of this study are acknowledged and greatly appreciated. The authors used AI-assisted tools for language refinement and editing; all content, analysis, and interpretation remain the responsibility of the authors.
Author contributions
M.F.M.I.: Study conception, research design, data collection, data analysis, and manuscript writing. N.S.I.M.R.: Literature review support, data interpretation, and manuscript review. F.E.: Methodological guidance, manuscript review, and critical revision of intellectual content. S.Z.S.: Critical revision of intellectual content and manuscript editing.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests
The authors declare that they have no competing interests.
Ethical approval
The study adhered to strict ethical guidelines and obtained ethics approval from the Kulliyyah of Nursing Postgraduate & Research Committee (KNPGRC), IIUM Research Ethics Committee (Id: IREC2024-117) and Sultan Ahmad Shah Medical Centre (SASMEC) (IIR24-63). Informed consent was secured from all participants, ensuring they understood the purpose, procedures, and voluntary nature of the study. Confidentiality and anonymity were guaranteed, with personal identifiers removed to protect participants’ privacy. Participants were also informed of their right to withdraw from the study at any point, without any adverse consequences. These ethical measures ensured that the study was conducted with respect, integrity, and transparency, fostering trust between the researcher and participants.
Open access
